Skip to main content
SpringerLink
Log in

Internet-Based Smoking Cessation Initiatives

Availability, Varieties, and Likely Effects on Outcomes

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

Tobacco use remains widespread in every nation in the world. Worldwide, >1.3 billion people use tobacco products. Many smokers who attempt to quit need cessation assistance such as education, motivation, counseling, and pharmacologic treatments, but many lack access to these resources because of geographic isolation, economic constraints, and cultural barriers. As global Internet use continues to grow, Internet-based smoking cessation programs are a promising strategy for reaching smokers worldwide.

The purpose of this article is to examine Internet-based initiatives to assist smokers to quit. The advantages and disadvantages of this type of forum, the likely effectiveness in achieving smoking cessation, and the impact on clinical and cost outcomes are discussed. The primary advantage of Internet-based smoking cessation initiatives is their potential public health reach. Disadvantages include the potential for privacy and security breaches, concerns about inferior quality of information, and failure of websites to utilize online technologies.

Internet-based smoking cessation programs can extend the clinical encounter, in essence allowing the provider to offer ‘virtual’ support to the patient who is attempting to quit smoking. The potential of Internet technology to reach large numbers of smokers and provide reliable information for quitting is only beginning to be realized. Few studies have rigorously examined the question of efficacy, and many questions remain unanswered.

To illustrate the important features of Internet-based smoking cessation initiatives, this review evaluated existing online programs. A smoking cessation program was defined as a structured, multi-component treatment plan specifically designed to aid in quitting. Twelve websites were identified from an Internet search (using an Internet search engine) that met our criteria. The interactive capabilities of Internet applications show great promise for customizing a smoking cessation plan ‘on-the-fly’ for individuals seeking support in quitting, but few websites offer programs that incorporate tailored approaches. Thus, patients should look to healthcare providers to help them understand the benefits and limitations of Internet-based information resources for smoking cessation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

Notes

  1. In Internet searches conducted on September 28, 2006, http://www.msn.com returned 522 455 hits, http://www.yahoo.com returned 11 600 000 hits, http://www.google.com returned 14 900 000 hits, and http://www.altavista.com returned 19 800 000 hits.

References

  1. da Costa e Silva V, editor. Tools for advancing tobacco control in the XXIst century: policy recommendations for smoking cessation and treatment of tobacco dependence [online]. Geneva: World Health Organization, 2003. Available from URL: http://www.who.int/tobacco/resources/publications/tobacco_dependence/en/index.html [Accessed 2006 Aug 31]

  2. Shafey O, Dolwick S, Guindon GE. Tobacco control country profiles. 2nd ed. Geneva: World Health Organization, 2003 [online]. Available from URL: http://www.who.int/tobacco/global_data/country_profiles/en/ [Accessed 2006 Aug 31]

    Google Scholar 

  3. US Centers for Disease Control and Prevention. Cigarette smoking among adults: United States, 2000 [online? MMWR 2002; 51(29): 642–645. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5129a3.htm [Accessed 2006 Aug 31]

    Google Scholar 

  4. Internet World Stats. Miniwatts International, Ltd. Internet usage statistics: the big picture [online]. Available from URL: http://www.internetworldstats.com/stats.htm [Accessed 2006 Aug 31]

  5. Fox S, Rainie L. The online health care revolution: how the web helps Americans take better care of themselves [online]. Washington, DC: Pew Internet & American Life Project, 2000. Available from URL: http://www.pewinternet.org/pdfs/PIP_Health_Report.pdf [Accessed 2006 Aug 31]

  6. Eysenbach G. Recent advances: consumer health informatics. BMJ 2000; 320: 1713–6

    Article  PubMed  CAS  Google Scholar 

  7. McDaniel AM, Stratton RM. Consumer health informatics: the nature of caring in the 21st century. In: Weaver C, Delaney CW, Weber P, et al., editors. Nursing and informatics for the 21st century: an international look at practice, trends, and the future. Chicago (IL): Health Information Management Systems Society, 2006

    Google Scholar 

  8. Coiera E. Interaction design theory. Int J Med Inform 2003; 69(2-3): 205–22

    Article  PubMed  Google Scholar 

  9. Bock BC, Graham A, Sciamanna CN, et al. Smoking cessation treatment on the internet: content, quality, and usability. Nicotine Tob Res 2004 Apr; 6(2): 207–19

    Article  PubMed  Google Scholar 

  10. Lewis D. Computers in patient education. Comput Inform Nurs 2003; 21(2): 88–96

    Article  PubMed  Google Scholar 

  11. Stoop AP, van Riet A, Berg M. Using information technology for patient education: realizing surplus value? Patient Educ Couns 2003; 54(2): 187–95

    Article  Google Scholar 

  12. Fiore MC, Bailey SJ, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville (MD): US Department of Health and Human Services, 2000

    Google Scholar 

  13. Booth BM, McLaughin YS. Barriers to and need for alcohol services for women in rural populations. Alcohol Clin Exp Res 2000; 24(8): 1267–75

    Article  PubMed  CAS  Google Scholar 

  14. Committee on Communications for Behavior Change in the 21st Century. Speaking of health: assessing health communication strategies for diverse populations. Washington, DC: National Academies Press, 2002

    Google Scholar 

  15. Chisholm W, Vanderheiden G, Jacobs I, editors. W3C World Wide Web Consortium. Web content accessibility guidelines 1.0: W3C Recommendation 5-May-1999 [online]. Available from URL: http://www.w3.org/TR/1999/WAI-WEBCONTENT-19990505/ [Accessed 2006 Aug 31]

  16. Henry SL, editor. W3C World Wide Web Consortium. Overview of WCAG 2.0 documents [online]. Available from URL: http://www.w3.org/WAI/intro/wcag20 [Accessed 2006 Aug 31]

  17. Smokefree.gov. Online guide to quitting [online]. Available from http://www.smokefree.gov/ [Accessed 2006 Sep 15]

  18. Lenhart A, Horrigan J, Rainie L, et al. The ever-shifting Internet population: a new look at Internet access and the digital divide [online]. Washington, DC: Pew Internet & American Life Project, 2003. Available from URL: http://www.pewinternet.org/pdfs/PIP_Shifting_Net_Pop_Report.pdf [Accessed 2006 Aug 31]

  19. Silagy C. Physician advice for smoking cessation. Cochrane Database Syst Rev 2001; (2): CD000165

    PubMed  Google Scholar 

  20. Anderson JG, Rainey MR, Eysenbach, et al. The impact of cyberhealthcare on the physician-patient relationship. J Med Syst 2003; 27(1): 67–84

    Article  PubMed  Google Scholar 

  21. Jaen CR, McIlvain H, Pol L, et al. Tailoring tobacco counseling to the competing demands in the clinical encounter. J Fam Pract 2001; 50(10): 859–63

    PubMed  CAS  Google Scholar 

  22. Mautone PD, Mayer RE. Signaling as a cognitive guide in multimedia learning. J Educ Psychol 2001; 93(2): 377–89

    Article  Google Scholar 

  23. Mayer RE, Mathias A, Wetzeil K. Fostering understanding of multimedia messages through pre-training evidence for a two-stage theory of mental model construction. J Exp Psychol Appl 2002; 8(3): 147–54

    Article  PubMed  Google Scholar 

  24. Stratton RM, McDaniel AM, Legge NK. Quit for life: an interactive computer program promoting smoking cessation in low income rural communities. HCI 11th International Conference on Human-Computer Interaction [CD-Rom]. Mahwah (NJ): Lawrence Erlbaum Associates Inc, Publishers, 2005

    Google Scholar 

  25. Jones JM, Nyhof-Young J, Friedman A, et al. More than just a pamphlet: development of an innovative computer-based education program for cancer patients. Patient Educ Couns 2001; 44(3): 271–81

    Article  PubMed  CAS  Google Scholar 

  26. Mayer RE, Chandler P. When learning is just a click away: does simple user interaction foster deeper understanding of multimedia messages? J Educ Psychol 2001; 92(2): 390–197

    Article  Google Scholar 

  27. Van Mierlo Communications Consulting, Inc. The Stop Smoking Center [online]. Available from URL: http://www.stopsmokingcenter.net [Accessed 2006 Sep 15]

  28. Kreuter MW, Bull FC, Clark EM, et al. Understanding how people process health information: a comparison of tailored and nontailored weight-loss materials. Health Psychol 1999; 18(5): 487–94

    Article  PubMed  CAS  Google Scholar 

  29. Strecher VJ. Computer-tailored smoking cessation materials: a review and discussion. Patient Educ Couns 1999; 36(2): 107–17

    Article  PubMed  CAS  Google Scholar 

  30. Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev 2002; (3): CD001118

    PubMed  Google Scholar 

  31. Shiffman S, Paty JA, Rohay JM, et al. The efficacy of computer-tailored smoking cessation material as a supplement to nicotine polacrilex gum therapy. Arch Intern Med 2000; 160: 1675–81

    Article  PubMed  CAS  Google Scholar 

  32. Etter JF, Perneger TV. Effectiveness of a computer-tailored smoking cessation program: a randomized trial. Arch Intern Med 2001; 1611: 2596–601

    Article  Google Scholar 

  33. Johnson GJ, Ambrose PJ. Neo-tribes: the power and potential of online communities in health care. Commun ACM 2006; 49(1): 107–13

    Article  Google Scholar 

  34. Eysenbach G, Powell J, Englesakis M, et al. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ 2004; 328(7449): 1166–72

    Article  PubMed  Google Scholar 

  35. Evers KE, Prochaska JM, Prochaska JO, et al. Strengths and weaknesses of health behavior change programs on the internet. J Health Psychol 2003; 8: 63–70

    Article  PubMed  Google Scholar 

  36. Schoenberg R. Security of healthcare information systems. In: Lewis D, Eysenbach G, Kukafka R, et al., editors. Consumer health informatics. New York: Springer, 2005

    Google Scholar 

  37. Fontaine N, Voynet D. Regulation (EC) no. 45/2001 of the European Parliament and the of the Council of 18 December 2000 on the protection of individuals with regard to the processing of personal data by the community institutions and bodies and on the free movement of such data [online]. Official Journal of the European Union 2001; L8: 1-22. Available from URL: http://eur-lex.europa.eu/LexUriServ/site/en/oj/2001/l_008/l_00820010112en00010022.pdf [Accessed 2006 Aug 31]

  38. Eysenbach G, Powell J, Kuss O, et al. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002; 287(20): 2691–1700

    Article  PubMed  Google Scholar 

  39. Cheh JA, Ribisl KM, Wildemuth BM. An assessment of the quality and usability of smoking cessation information on the internet. Health Promot Pract 2003; 4(3): 278–87

    Article  PubMed  Google Scholar 

  40. Fox S, Rainie L. Vital decisions: how Internet users decide what information to trust when they or their loved ones are sick [online]. Washington DC: Pew Internet & American Life Project, 2002. Available from URL: http://www.pewinternet.org/pdfs/PIP_Vital_Decisions_May2002.pdf [Accessed 2006 Aug 31]

    Google Scholar 

  41. Frisby G, Bessell TL, Borland R, et al. Smoking cessation and the internet: a qualitative method examining online consumer behavior. J Med Internet Res 2002; 4(2): E8

    Article  PubMed  Google Scholar 

  42. Schneider SJ, Walter R, O’Donnell R. Computerized communication as a medium for behavioral smoking cessation treatment: controlled evaluation. Comput Human Behav 1990; 6: 141–51

    Article  Google Scholar 

  43. Lenert L, Muñoz RF, Stoddard J, et al. Design and pilot evaluation of an internet smoking cessation program. J Am Med Inform Assoc 2003; 10(1): 16–20

    Article  PubMed  Google Scholar 

  44. Lenert L, Muñoz RF, Perez JE, et al. Automated e-mail messaging as a tool for improving quit rates in an internet smoking cessation intervention. J Am Med Inform Assoc 2004; 11(4): 235–40

    Article  PubMed  Google Scholar 

  45. Muñoz RF, Lenert L, Delucchi K, et al. Toward evidence-based Internet interventions: a Spanish/English web site for international smoking cessation trials. Nicotine Tob Res 2006; 8(1): 77–87

    Article  PubMed  Google Scholar 

  46. Feil EG, Noell J, Lichtenstein E, et al. Evaluation of an Internet-based smoking cessation program: lessons learned from a pilot study. Nicotine Tob Res 2003; 5(2): 189–94

    Article  PubMed  Google Scholar 

  47. Axia Health Management. QuitNet [online]. Available from URL: http://www.quitnet.com [Accessed 2006 Sep 15]

  48. Cobb NK, Graham AL, Bock BC, et al. Initial evaluation of a real-world internet smoking cessation system. Nicotine Tob Res 2005; 7(2): 207–16

    Article  PubMed  Google Scholar 

  49. Strecher VJ, Shiftman S, West R. Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 2005; 100(5): 682–8

    Article  PubMed  Google Scholar 

  50. Etter JF. Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: a randomized trial. J Med Internet Res 2005; 7(1): e2

    Article  PubMed  Google Scholar 

  51. Université de Genève Institut de Médecine Sociale et Préventive. Stop-tabac.ch [online]. Available from URL: http://www.stop-tabac.ch/ [Accessed 2006 Oct 10]

  52. Prochaska JO, Velicer WF, Rossi JS, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994; 13(1): 39–46

    Article  PubMed  CAS  Google Scholar 

  53. Swartz LH, Noell JW, Schroeder SW, et al. A randomised control study of a fully automated internet based smoking cessation programme. Tob Control 2006; 15(1): 7–12

    Article  PubMed  CAS  Google Scholar 

  54. Cook C, Heath F, Thompson RL. A meta-analysis of response rates in web- or Internet-based surveys. Educ Psychol Meas 2000; 60(6): 821–36

    Article  Google Scholar 

  55. Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to help people stop smoking: findings for the Cochrane Library. BMJ 2000; 321: 355–8

    Article  PubMed  CAS  Google Scholar 

  56. McDaniel AM, Casper GR, Hutchison S, et al. Design and testing of an interactive smoking cessation intervention for inner-city women. Health Educ Res 2005; 20(3): 379–84

    Article  PubMed  Google Scholar 

  57. Smoking Control Systems [online]. Available from URL: http://www.smoking-controlsystems.com [Accessed 2006 Sep 15]

  58. Salveson C. WebMD.com. 4 weeks to being smoke-free [online]. Available from URL: http://boards.webmd.com/webx7.14@963.cflNb91WNc8.0@.59ac9102 [Accessed 2006 Sep 15]

  59. American Lung Association. Freedom from smoking [online]. Available from URL: http://www.ffsonline.org [Accessed 2006 Sep 15]

  60. University of Rochester. Clear Horizons [online]. Available from URL: http://www.myclearhorizons.com/ [Accessed 2006 Sep 15]

  61. GlaxoSmithKline. Committed Quitters [online]. Available from http://committed-quitters.quit.com/ [Accessed 2006 Sep 15]

  62. Health Canada. On the Road to Quitting program [online]. Available from http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/quit-cesser/now-maintenant/road-voie/program/index_e.html [Accessed 2006 Sep 15]

  63. Lung Association of Saskatchewan. To quit or not to quit? [online] Available from URL: http://www.sk.lung.ca/content.cfm?edit_realword=cessation [Accessed 2006 Sep 15]

  64. Massachusetts Department of Public Health. QuitWorks [online]. Available from http://www.trytostop.org/ [Accessed 2006 Sep 15]

  65. Health Canada. Quit 4 Life [online]. Available from http://www.quit41ife.com/ [Accessed 2006 Sep 15]

  66. Ready, Set, Stop! Online [online]. Available from URL: https://www.wellmed.com/NBWHP/default.aspx?secure=l&startID=46 [Accessed 2006 Sep 15]

  67. Cummins CO, Prochaska JO, Driskell MM, et al. Development of review criteria to evaluate health behavior change websites. J Health Psychol 2003; 8: 55–62

    Article  PubMed  Google Scholar 

  68. Monahan G, Colthurst T. Internet-based information on alcohol, tobacco, and other drugs: issues of ethics, quality, and accountability. Subst Use Misuse 2001; 36(14): 2171–80

    Article  PubMed  CAS  Google Scholar 

  69. Coggan JM. AARP: evaluating health information on the internet. J Consum Health Internet 2003; 7(4): 61–6

    Article  Google Scholar 

  70. Health on the Net Foundation. HON code of conduct (HONcode) for medical and health Web sites [online]. Available from URL: http://www.hon.ch/HONcode/Conduct.html [Accessed 2006 Aug 31]

  71. Usability.gov. United States Department of Health and Human Services. Questions to ask at kick-off meetings [online]. Available from URL: http://www.usability.gov/templates/kickoffmeeting.pdf [Accessed 2006 Aug 31]

  72. Bensley RJ, Lewis, JB. Analysis of internet based assessments. Health Promot Pract 2002; 3(4): 473–6

    Article  Google Scholar 

  73. Cumbo A, Agre P, Dougherty J, et al. Online cancer patient education: evaluating usability and content. Cancer Pract 2002; 10(3): 155–61

    Article  PubMed  Google Scholar 

  74. US National Cancer Institute. How to evaluate health information on the internet: questions and answers [online]. Available from URL: http://www.cancer.gov/cancertopics/factsheet/Information/internet [Accessed 2006 Aug 31]

  75. Frisby G, Bessell TL, Borland R, et al. Smoking cessation and the Internet: a qualitative method examining online consumer behavior. J Med Internet Res 2002; 4(2): E8

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Preparation of this study was supported, in part, by the Walther Cancer Institute (Indianapolis, IN, USA). The authors have no conflicts of interest that are directly relevant to the contents of this study.

Author information

Authors and Affiliations

  1. Indiana University School of Nursing, 1111 Middle Drive, Indianapolis, Indiana, 46202, USA

    Anna M. McDaniel

  2. Walther Cancer Institute, Indianapolis, Indiana, USA

    Renée M. Stratton

Authors
  1. Anna M. McDaniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renée M. Stratton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna M. McDaniel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McDaniel, A.M., Stratton, R.M. Internet-Based Smoking Cessation Initiatives. Dis-Manage-Health-Outcomes 14, 275–285 (2006). https://doi.org/10.2165/00115677-200614050-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200614050-00003

Keywords

Search

Navigation